Avicenna Medical Group, Llc

NPI 1194067959 - Counselor - 101YM0800X

NPI Details
NPI 1194067959
Enumeration Date 03/20/2013
Last Updated 03/22/2013
Entity Type Healthcare Provider
Active Over 3 years ago
Authorized Information
Name FADI FADI
Position MANAGER
Phone (646) 464-3110
Fax
Practice Location
414 EAGLE ROCK AVE
SUITE 307
WEST ORANGE NJ, 07052-4224, US
Phone (646) 464-3110
Fax
Business Location
414 EAGLE ROCK AVE
SUITE 307
WEST ORANGE NJ, 07052-4224, US
Phone (646) 464-3110
Fax
Toxanomy
Taxonomy Code 101YM0800X
License State New Jersey
License Number 25MB07627000
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According to our database, Avicenna Medical Group, Llc NPI is 1194067959, taxonomy code is 101YM0800X and license number is 25MB07627000, license state is located at New Jersey. Avicenna Medical Group, Llc physically located at 414 Eagle Rock Ave, West Orange NJ, 07052-4224. NPI Number 1033115704 has the healthcare provider type.

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1194067959 NPI number is provided on an as is basis without warranty of any kind. 1194067959 is maintained by the National Plan & Provider Enumeration System. The contents of Avicenna Medical Group, Llc are for informational purposes only.